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Year 3 - OSCE Resp > CXR > Flashcards

CXR Flashcards

1
Q

What’s the first thing you do when interpreting a CXR?

A

Confirm the patient’s details:

  • name, DOB, hosp no.
  • date and time of film
  • previous imaging
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2
Q

What’s the next step after confirming patient’s details?

A

Assess the quality of the image (RIPE)

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3
Q

What does RIPE stand for?

A

Rotation
Inspiration
Projection
Exposure

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4
Q

What do you check for in ‘rotation’?

A

Clavicles should be equidistant to spinous processes

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5
Q

What do you check for in ‘inspiration’?

A

5-6 anterior ribs OR

10-11 posterior ribs should be visible

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6
Q

How do you know which ones the anterior ribs are?

A

The anterior ribs are the ones that curve downwards

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7
Q

What do you check for in ‘projection’?

A

PA or AP

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8
Q

Differentiate between AP and PA

A 
PA = scapula more lateral 
AP = scapula more medial
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9
Q

What do you check for in ‘exposure’?

A

Vertebrae should be visible behind the heart

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10
Q

What is one key thing you should always remember about the AP?

A

Heart size cannot be assessed accurately on an AP as it is imaged from the front!! Therefore beware of it seeming like cardiomegaly when it’s actually normal!

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11
Q

What does the ABCDE stand for?

A 
Airway 
Breathing 
Cardiac
Diaphragm 
Everything else
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12
Q

What do you look for when assessing the airway?

A

Trachea - is it deviated or central?
Carina and bronchi - association with NG tube
Hilar structures - are they symmetrical bilaterally or unilaterally?

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13
Q

What could bilateral hilar enlargement suggest?

A

Sarcoidosis/TB

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14
Q

What do you when assessing breathing?

A

Lung fields - look by thirds

Pleura - normally shouldn’t be visible

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15
Q

What might a thickened pleura suggest?

A

Mesothelioma due to asbestos

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16
Q

What might pleura that doesn’t extend to the edge suggest?

A

Pneumothorax

17
Q

What might opacification in the lower lobes suggest?

A

Pneumonia

18
Q

What do you assess when looking at the cardiac side of things?

A 
Heart size (PA) 
Heart borders
19
Q

When would it be classified as cardiomegaly?

A

When heart size >50% thoracic width​

20
Q

What would reduced definition of the right heart border suggest?

A

Right middle lobe consolidation

21
Q

What would reduced definition of the left heart border suggest?

A

Reduced definition of left heart border = lingula consolidation​

22
Q

Which diaphragm is normally higher?

A

right one

left is lower

23
Q

What else do you look for when assessing diaphragm?

A

Costophrenic angles
-fluid
-consolidation
lung hyperinflation

24
Q

What do you call it when there is air under the diaphragm?

A

Pneumoperitoneum

25
Q

What counts as ‘everything else’?

A 
Aortic knuckle​
Mediastinal width​
Bones​
Soft tissues​
Tubes, valves, pacemakers​
26
Q

Finally, what areas must you review?

A

HARP

Hilar regions
Apices
Retrocardiac regions
Peripheries

27
Q

What do you call metastatic lung cancer that presents as multiple fluffy spots in the lungs?

A

Cannonball metastases

28
Q

As part of management, what do you need to say?

A

Investigations as well as next steps

29
Q

What would be part of investigations? Bloods? Imaging? Other?

A

Bloods:

  • ABGs/VBGs
  • FBC
  • U&Es
  • D-dimer
  • Troponin
  • BNPs

Imaging
-echocardiogram

Check for ankle swelling

30
Q

Management might include

A 
Sitting them up, 45 degrees
Oxygen 
Loop diuretics (if pul oedema, pleural effusion) 
Nitrate
CPAP

Antibiotics

31
Q

What can venous blood gas tell you that ABGs won’t tell you?

A

lactic acid

32
Q

When should you not give nitrates?

A

Aortic stenosis

Low BP

33
Q

What differentiates an AP xray?

A

Scapula shadow

34
Q

If you see a patient with consolidation that suggests pneumonia, what would you need to do?

A 
If pneumonia, do CURB65 
FBC
U and E 
CRP/ESR 
Blood culture
Arterial blood gas

Check whether the patient has had any previous hospitalisation due to similar chest infection

35
Q

What imaging test would you need to do if the pneumonia doesn’t improve?

A

CT after 3 weeks

Year 3 - OSCE Resp (6 decks)

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